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July 18, 2008

Cipro Warning May Be ‘Overreaction': Local Doctors Say Antibiotic Safe If Used Properly

by Sam Savage

By Melissa McEver, The Brownsville Herald, Texas

Jul. 18--Rio Grande Valley physicians say they still plan to prescribe the antibiotic Cipro and similar drugs despite a federal government's warning that the medicines could cause tendon infections and rupture.

If used properly and sparingly, Cipro and other antibiotics known as fluoroquinolones are safe for most patients, doctors said.

"I'm very comfortable prescribing it," said Dr. Bruce Leibert, Harlingen family practice physician. "I have yet to hear of any tendon effects on adults ... and we've had very good successes with it."

Last week, the U.S. Food and Drug Administration ordered drug manufacturers to add a "black-box warning" to these antibiotics, advising patients about the risk of tendon problems. The fluoroquinolones already carried a warning about this possible side effect, but FDA officials felt the warning needed to be stronger, the agency said in a news release.

Consumer group Public Citizen filed a lawsuit against the FDA in January, calling for the agency to strengthen its warnings against fluoroquinolones. In its lawsuit, the group said "a simple non-bolded warning buried in the list of possible adverse reactions to fluoroquinolones has proved inadequate.

"Fluoroquinolone-induced tendon injuries continue to occur at an alarming rate," the lawsuit said.

A Brownsville physician said he thought the FDA's decision to add a black-box warning "might be an overreaction."

"If (the antibiotic) is used the way it should be used, it shouldn't harm anyone," said pediatrician Dr. Jorge Dominguez, who prescribes the drug occasionally for teenagers older than 14. "I'll continue to use it when it's needed, which is seldom."

Cipro is an effective antibiotic for urinary tract infections and illnesses that don't respond to other antibiotics, local doctors said.

Doctors said they don't prescribe the medication for children, patients who are taking steroid drugs or athletes.

The FDA said the risk of tendon rupture also is greater in people older than 60 and in patients who have received organ transplants.

Cipro isn't as effective as other antibiotics for the types of infections seen in this region, said Dr. Lorenzo Pelly, Brownsville internal medicine specialist. Pelly more often prescribes Levaquin, another fluoroquinolone. Pelly considers it a safe drug and has never seen adverse effects in patients, he said.

"I've prescribed it to family members," Pelly said.

Leibert said he'll advise patients of the medications' risks, and suggests that patients talk to their doctors about any concerns. But for patients with a persistent infection, sometimes this type of antibiotic is the best answer, he said.